Atypical depression

Atypical depression, or depression with atypical features as it has been known in the DSM IV, is depression that shares many of the typical symptoms of the psychiatric syndromes major depression or dysthymia but is characterized by improved mood in response to positive events. In contrast, people with melancholic depression generally do not experience an improved mood in response to normally pleasurable events. Atypical depression also features significant weight gain or an increased appetite, hypersomnia, a heavy sensation in the limbs and interpersonal rejection sensitivity that results in significant social or occupational impairment.^[1]

Despite its name, "atypical" depression does not mean it is uncommon or unusual.^[2] The reason for its name is twofold: (1) it was identified with its "unique" symptoms subsequent to the identification of melancholic depression and (2) its responses to the two different classes of antidepressants that were available at the time were different from melancholic depression (i.e., MAOIs had clinically significant benefits for atypical depression, while tricyclics did not).^[3]

Atypical depression is two to three times more common in women than in men.^[1] Individuals with atypical features tend to report an earlier age of onset (e.g. while in high school) of their depressive episodes, which also tend to be more chronic^[4] and only have partial remission between episodes. Younger individuals may be more likely to have atypical features, whereas older individuals may more often have episodes with melancholic features.^[1] Atypical depression has high comorbidity of anxiety disorders, carries more risk of suicidal behavior, and has distinct personality psychopathology and biological traits.^[4] Atypical depression is more common in individuals with bipolar I,^[4] bipolar II,^[4][5] cyclothymia^[4] and seasonal affective disorder.^[1] Depressive episodes in bipolar disorder tend to have atypical features,^[4] as does depression with seasonal patterns.^[6]

Symptoms

The DSM-IV-TR defines Atypical Depression as a subtype of Major Depressive Disorder with Atypical Features, characterized by:

1. Mood reactivity (i.e., mood brightens in response to actual or potential positive events)
2. At least two of the following:
   • Significant weight gain or increase in appetite;
   • Hypersomnia (sleeping too much, as opposed to the insomnia present in melancholic depression);
   • Leaden paralysis (i.e., heavy, leaden feelings in arms or legs);
   • Long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment.
3. Criteria are not met for With Melancholic Features or With Catatonic Features during the same episode.

Research

In general, atypical depression tends to cause greater functional impairment than other forms of depression. Atypical depression is a chronic syndrome that tends to begin earlier in life than other forms of depression—usually beginning in the teenage years. Similarly, patients with atypical depression are more likely to suffer from personality disorders and anxiety disorders such as borderline personality disorder, avoidant personality disorder, generalized anxiety disorder, obsessive-compulsive disorder, and bipolar disorder.^[1]

Recent research suggests that young people are more likely to suffer from hypersomnia while older people are more likely to suffer from polyphagia.^[7]

Medication response differs between chronic atypical depression and acute melancholic depression. Some studies^[8] suggest that the older class of antidepressants, monoamine oxidase inhibitors (MAOIs), may be more effective at treating atypical depression. While the more modern SSRIs and SNRIs are usually quite effective in this illness, the tricyclic antidepressants typically are not.^[1] The wakefulness-promoting agent modafinil has shown considerable effect in combating atypical depression, maintaining this effect even after discontinuation of treatment.^[9] Antidepressant response can often be enhanced with supplemental medications, such as buspirone, bupropion, or aripiprazole. Psychotherapy, whether alone or in combination with medication, is also an effective treatment.

See also

• Masked depression

References

Additional resources

1. Atypical Depression Actually Very Typical
2. Stewart JW, Quitkin FM, McGrath PJ, Klein DF (2005). "Defining the boundaries of atypical depression: evidence from the HPA axis supports course of illness distinctions". Journal of Affective Disorders. 86 (2-3): 161–7. PMID 15935235. doi:10.1016/j.jad.2005.01.009. 
3. Atypical Depression - Depression Central Mood Disorders & Treatment, Satish Reddy, MD., Editor (Formerly Dr. Ivan Goldberg's Depression Central)